"Boutique Medicine"

[terpkristin]

Anybody else seen this?
Health Insurance: Faced With A Broken Health Care System, Some Doctors Are Opting-Out

The practice referenced in the Baltimore Sun article, Charter Internal Medicine, used to be where I went for my PCP, and is where my folks still go. They are undecided if they'll stay with the practice. On the one hand, they both very much like their physicians. On the other hand, their health insurance premiums are going up regardless, and this would be an added expense as they're starting to think of retiring...

Also, while I was at the gym today, I saw a piece on the news about a local (DC) doctor who has his practice online: Welcome to howardstarkmd.com

Is this becoming common anywhere else? I'm surprised by it, but then, since moving down to northern VA, I haven't found a primary care doc. I find myself going to Urgent Care about once a year for a massive sinus infection, and other than that, my orthopaedists are my primary care physicians. It doesn't help that the one "primary care doc" I had found referred to my ovaries as my "woman parts" so I decided not to go back there.

Just wondering if others were seeing things like this, and what y'all thought.

/tk

[Galaxy]

It doesn't cover the cost of drugs, x-rays, doctor's fees, correct?

[terpkristin]

Originally Posted by Galaxy

It doesn't cover the cost of drugs, x-rays, doctor's fees, correct?

Right. As far as I understand, anyway...the up front money is more of a retainer.

/tk

[JonInMiddleGA]

Although I was aware of it for several years, saw it first hand for the first time in the past year right down the street from me.

Was a combo Urgent Care (aka Doc In A Box) & Concierge Care practice with two doctors. The idea seemed to be that they'd do the former to keep them afloat until they could build up the latter.

About $4k a year guaranteed you access within an hour, with cost of most services still billable (except for annual wellness type stuff) Sounded like an okay deal if you made a significant number of visits a year and could swing the fee without any problem.

Alas, their business model apparently failed them as they went under about six months ago (lasted about a year give or take).

I like it in theory, in practice it seems a lot more "is this the right plan for you?" I mean, I've seen a doctor less than a half dozen times in the past decade, which seems to mean that I'd have to have a lot more money than sense to pay the annual fee for something I'd likely use less than once a year.

[Eaglesfan27]

Interesting article. In my limited private practice (I only do 4 hours per week), I don't take any insurance. It is all cash up front and that has been the norm for many physicians in my field for at least the last 5-10 years.

[Galaxy]

Originally Posted by Eaglesfan27

Interesting article. In my limited private practice (I only do 4 hours per week), I don't take any insurance. It is all cash up front and that has been the norm for many physicians in my field for at least the last 5-10 years.

Do you see this happening more in other surgical fields (like you see in cosmetic/plastic surgery) as time goes by? I know that a lot of doctors/surgeons are not accepting new Medicare/Medicaid (or drop taking it all together).

[stevew]

In theory, couldn't small towns/groups start actually buying doctors/facilities? Sort of like a credit union for health care. (maybe this is what an HMO is?)

Basically you live in a town, the town facility is open to members of the town, you have a set amount of dues per month. A large amount of dues goes towards the facility, paying the doctor(s) and nurses, for all your basic visits, etc. You'd have your co-pay, etc. And then a smaller amount of the dues would be set aside each month in case you needed procedures that were beyond the scope of the facility. Plus you'd have a separate traditional insurance type option for catastropic care, etc. I'm not a big fan of nationalized health care, but I could see City wide being somewhat effective. Basically you don't have to pay extreme costs to cover for those who aren't paying, and don't live in your area. There could even be some sort of limited tort type stuff, in order to keep the insurance costs low for a doctor.

[Eaglesfan27]

Originally Posted by Galaxy

Do you see this happening more in other surgical fields (like you see in cosmetic/plastic surgery) as time goes by? I know that a lot of doctors/surgeons are not accepting new Medicare/Medicaid (or drop taking it all together).

Very possible, particularly if medicaid/medicare continues to cut their reimbursement rates.

[Shkspr]

Originally Posted by stevew

In theory, couldn't small towns/groups start actually buying doctors/facilities? Sort of like a credit union for health care. (maybe this is what an HMO is?)

Socialist.

[albionmoonlight]

Originally Posted by stevew

In theory, couldn't small towns/groups start actually buying doctors/facilities? Sort of like a credit union for health care. (maybe this is what an HMO is?)

Basically you live in a town, the town facility is open to members of the town, you have a set amount of dues per month. A large amount of dues goes towards the facility, paying the doctor(s) and nurses, for all your basic visits, etc. You'd have your co-pay, etc. And then a smaller amount of the dues would be set aside each month in case you needed procedures that were beyond the scope of the facility. Plus you'd have a separate traditional insurance type option for catastropic care, etc. I'm not a big fan of nationalized health care, but I could see City wide being somewhat effective. Basically you don't have to pay extreme costs to cover for those who aren't paying, and don't live in your area. There could even be some sort of limited tort type stuff, in order to keep the insurance costs low for a doctor.

The tort law would be controlled by the state, so a town could not opt-out of that aspect of things. Besides, I don't know if I would want to go to a Dr. who ran to go work in the "we don't recognize malpractice" town

More seriously, one of the problems you would have here is sick people moving into the town and healthy people moving out. Right now, I am blessed in that my family does not have any chronic health problems. So I would probably move just outside of your town, commute in, and not pay the dues.

But I would certainly move three blocks over and into town if my kid ever got asthma, I got the diabeetis, etc.

And, if everyone thought like me, the dues would have to go up to make up for the fact that more sick people lived there, which would make more well people move out and . . . well you see where that is going.

But I LOVE the outside the box thinking there.

[Galaxy]

Originally Posted by Eaglesfan27

Very possible, particularly if medicaid/medicare continues to cut their reimbursement rates.

What do think will happen if doctors continue to opt out?